Epidural versus Intra-Articular Infusion Analgesia following Total Knee Replacement

Kasture, Sarang; Saraf, Hrushikesh

doi:10.1177/230949901502300304

Cited by 16 publications

(7 citation statements)

References 13 publications

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“…of patients Dose and methods No. of patients Dose and methods Andersen et al 2010 [ 10 ] Denmark 67/69 50/40 21 Combination of wound infiltration and continuous intra-articular injection postoperatively 19 Continuous epidural infusion RCTs 30 days Binici et al 2014 [ 11 ] Turkey 70.8/67.9 0/5 15 Continuous peri-articular injection postoperatively (3 ml (60 mg) lidocaine) 15 Continuous epidural infusion RCTs 7 days Kasture and Saraf 2015 [ 12 ] India 67.2/67.5 12/15 40 300 ml of 0.125% bupivacaine with 5 ml ketorolac injection 35 Continuous epidural infusion (300 ml of 0.125% bupivacaine with 300 mcg fentanyl injection) RCTs 1 month Klasen et al 1999 [ 13 ] Germany 70/69 0/0 10 Single infiltration (1 mg morphine diluted in 20 ml of saline 0.9%) 10 Continuous epidural infusion (boluses of 2.5 mg of morphine) RCTs 2 months Spreng et al 2010 [ 14 ] Norway 67.2/65.8 30/41 37 Single-shot intraoperative peri-articular infiltration (ketorolac 30 mg and morphine 5 mg) 33 Continuous epidural infusion (ropivacaine 150 mg and epinephrine 0.5 mg added to isotonic saline) RCTs 16 days Tsukada et al 2014 [ 15 ] Japan NS NS 50 Single-shot intraoperative peri-articular infiltration 61 Continuous epidural infusion RCTs NS Tsukada et al 2015 [ 16 ] Japan NS ...…”

Section: Resultsmentioning

confidence: 99%

Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis

et al. 2018

J Orthop Surg Res

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BackgroundWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of local infiltration anesthesia (LIA) versus epidural analgesia (EPA) for postoperative pain control in total knee arthroplasty (TKA).MethodsIn December 2017, a systematic computer-based search was conducted in Pubmed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared LIA versus EPA for postoperative pain control in TKA were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12, 24 and 48, and 72 h. The secondary outcomes were the range of motion, the length of stay, and the occurrence of infection and nausea. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.ResultsSeven clinical studies with 251 patients (LIA = 124, EPA = 127) were included in the meta-analysis. There was no significant difference between LIA and EPA group in terms of the VAS score with rest at 12 and 24 h. LIA was associated with a reduction of the VAS score with rest at 48 and 72 h than EPA (P < 0.05). There was no significant difference between the LIA group and EPA group in terms of the VAS with mobilization at 24, 48, and 72 h (P > 0.05). And LIA was associated with an increase of the range of motion at 24 and 48 h (P < 0.05) and a reduction of the length of hospital stay (P < 0.05). What is more, LIA was associated with a reduction of the occurrence of the nausea.ConclusionsLIA has equivalent efficacy as EPA for pain control after TKA and shows an increase of the range of motion and a reduction of the occurrence of nausea and length of hospital stay. Due to the limited number of the included studies, more high-quality RCTs are still needed to identify the long-term effects of LIA for pain control after TKA.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0770-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis

et al. 2018

J Orthop Surg Res

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“…Compared with parenteral opioids, epidural analgesia provides better postoperative analgesia with less nausea, vomiting, and pruritus. However, some studies show that epidural anesthesia is associated with many adverse effects, such as urinary retention, hypotension, pruritus, and motor block. Among these, the main drawback of epidural anesthesia is inadvertent motor nerve block, which delays physical therapy and rehabilitation.…”

Section: Postoperative Analgesic Regimensmentioning

confidence: 99%

Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

218

165

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Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end‐stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and retention of urine, which limit their application in daily clinical practice. The aim of this review was to discuss the current postoperative pain management regimens for TKA. Our review of the literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications and delivery routes, including preemptive analgesia, neuraxial anesthesia, peripheral nerve blockade, patient‐controlled analgesia and local infiltration analgesia, and oral opioid/nonopioid medications. Multimodal analgesia provides superior pain relief, promotes recovery of the knee, and reduces opioid consumption and related adverse effects in patients undergoing TKA.

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“…In our study, the same drugs were used, but only in oral dosage form. Local infi ltration analgesia has emerged as an alternative postoperative analgesic regimen for femoral nerve blockade without affecting quadriceps muscle strength (12), adductor canal blockade with signifi cantly better postoperative pain control (13) and epidural anesthesia with less frequent adverse effects, such as urinary retention, hypotension and motor blockade (14). Nevertheless, there is still no consensus on the optimal composition and infi ltration technique of LIA.…”

Section: Discussionmentioning

confidence: 99%

A multimodal opioid-sparing pain management following total knee replacement

Lacko¹,

Matuska²,

Folvarsky³

et al. 2022

BLL

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OBJECTIVE: The purpose of this study is to compare the pain scores, opioid consumption, and range of motion of the operated knee after total knee replacement (TKR) in the 10-day follow-up period between a traditional opioid-containing pain management protocol and a multimodal opioid-sparing treatment protocol. METHODS: This prospective, randomized, single-center study included 90 patients (24 men and 66 women; mean age 69.7±7.2 years) undergoing TKR for osteoarthritis between October 2019 and October 2020. Patients were randomized into 3 cohorts for comparison: traditional opioid-containing pain management protocol (n=30), multimodal opioid-sparing pain management protocol (n = 30), and traditional opioidcontaining pain management protocol with additional local infi ltration analgesia (LIA). Changes in visual analog scale for pain (VAS), range of motion (ROM), and opioid consumption were compared between groups. RESULTS: A lower mean postoperative VAS score was observed in the opioid-sparing cohort, which was statistically signifi cant at all time points compared with the traditional cohorts. Mean total morphine consumption was signifi cantly lower in the opioid-sparing cohort (2.7 ± 5.8 MMEs) compared to the traditional (14.0±14.8 MMEs) and traditional with LIA cohorts (8.3 ± 9.5 MMEs; p < 0.05). The mean degree of fl exion of the operated knee of patients was signifi cantly greater in patients in the opioid-sparing group than in the other groups on the postoperative day 3 (opioid-sparing: 87.0 ± 11.2°; traditional: 74.1 ± 11.6°; traditional with LIA: 84.7±8.9°; p<0.05), as well as on day 10 (opioid-sparing: 99.3 ± 10.8°; traditional: 87.3 ± 12.4°; traditional with LIA: 92.5±9.7°; p < 0.05). The rate of adverse events after TKR did not differ between the groups. CONCLUSION: The results of this study suggest that a multimodal opioid-sparing pain protocol after TKR, which includes oral non-opioid medications and periarticular injection with bupivacaine, provides better pain relief and early functional gains with fewer rescue opioids compared to traditional opioid-based protocols (Tab. 4, Fig. 2, Ref. 22).

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Epidural versus Intra-Articular Infusion Analgesia following Total Knee Replacement

Cited by 16 publications

References 13 publications

Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis

Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis

Postoperative Pain Management in Total Knee Arthroplasty

A multimodal opioid-sparing pain management following total knee replacement

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